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Effect of Community-Based Cancer Navigation on Cancer Treatment Attendance among Patients in Nigeria

Abstract

Cancer remains a major public health concern in Nigeria and places substantial physical, psychological, social, and financial burdens on patients and their families. Effective cancer treatment often requires patients to navigate complex healthcare systems, attend multiple appointments, undergo diagnostic procedures, receive surgery, chemotherapy, radiotherapy, hormonal therapy, targeted therapy where indicated, and participate in regular follow-up care. However, many patients experience difficulties maintaining treatment attendance because of geographical barriers, transportation costs, financial constraints, long travel distances, limited knowledge of treatment schedules, fragmented healthcare services, fear and stigma, treatment-related side effects, and inadequate communication between patients and healthcare providers. Community-based cancer navigation provides patient-centred support closer to patients' communities through appointment coordination, treatment education, referral assistance, follow-up communication, transportation support, psychosocial support, and linkage to available cancer services. Such services may reduce barriers to accessing oncology care and improve patients' attendance at scheduled cancer treatment appointments. Against this background, this study investigates the effect of community-based cancer navigation on cancer treatment attendance among patients in Nigeria. The study will be anchored on the Social Ecological Model, Andersen's Behavioral Model of Health Services Use, and the Continuity of Care Model. The Social Ecological Model explains how individual, family, community, healthcare-system, and socioeconomic factors interact to influence cancer treatment access and utilization. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need factors, with community-based cancer navigation serving as an enabling mechanism that may reduce barriers to treatment attendance. The Continuity of Care Model emphasizes coordination, communication, consistency, and sustained support across different stages and providers of cancer care. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based cancer navigation may influence cancer treatment attendance among patients in Nigeria. The study will adopt a quantitative quasi-experimental or prospective cohort research design. The study population will comprise adult cancer patients receiving treatment in selected public and private oncology centres, teaching hospitals, specialist hospitals, and cancer treatment facilities in Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, oncology centres, and eligible cancer patients. Community-based cancer navigation will be assessed using indicators such as frequency of navigation contacts, appointment reminders, treatment schedule education, referral assistance, appointment coordination, transportation support, financial-resource linkage, psychosocial support, treatment counselling, side-effect education, follow-up communication, assistance with accessing diagnostic and treatment services, and linkage between community and oncology facilities. Cancer treatment attendance will be assessed using indicators such as attendance at scheduled chemotherapy appointments, radiotherapy sessions, surgical appointments, oncology consultations, diagnostic appointments, follow-up visits, medication collection appointments where applicable, missed appointments, delayed attendance, treatment interruptions, and loss to follow-up. Data will be collected using structured questionnaires, oncology treatment records, appointment registers, patient navigation records, medical records, referral documents, treatment schedules, follow-up records, and interviews with patients and caregivers. Descriptive statistics will be used to summarize participants' demographic and clinical characteristics, exposure to community-based cancer navigation, and treatment attendance patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of community-based cancer navigation on cancer treatment attendance. Where a quasi-experimental design is adopted, treatment attendance among patients receiving structured community-based navigation may be compared with attendance among similar patients receiving conventional oncology care, or attendance before and after implementation of navigation services may be compared. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based cancer navigation has a significant positive effect on cancer treatment attendance among patients in Nigeria. Patients who receive structured navigation services are expected to demonstrate higher attendance at scheduled cancer treatment appointments, fewer missed appointments, fewer treatment delays, and better continuity of oncology care than patients without access to navigation support. Appointment reminders and treatment-schedule education may improve patients' understanding of when and where care is required, while referral and appointment coordination may reduce confusion within complex healthcare systems. Transportation assistance and linkage to financial or social support may further reduce practical barriers to accessing treatment. Community-based follow-up may also enable navigators to identify patients at risk of missing appointments and connect them with appropriate assistance before treatment is interrupted. However, inadequate numbers of trained cancer navigators, limited oncology treatment capacity, high treatment costs, transportation difficulties, poor communication between healthcare facilities, stigma, treatment side effects, and weak referral systems may reduce the effectiveness of navigation services. The study therefore expects accessible, coordinated, adequately trained, and patient-centred community-based cancer navigation to contribute significantly to improved cancer treatment attendance in Nigeria. The study is expected to contribute to the literature on community-based cancer navigation, cancer treatment attendance, patient navigation, oncology care, treatment adherence, cancer service utilization, treatment interruption, community-based healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Cancer Control Programme, state ministries of health, teaching hospitals, oncology centres, cancer treatment facilities, oncologists, oncology nurses, social workers, community health workers, patient navigators, cancer advocacy organizations, development partners, and policymakers regarding strategies for improving access to cancer treatment. The study will also provide evidence-based recommendations for expanding community-based cancer navigation programmes, training and deploying patient navigators, strengthening appointment reminder and follow-up systems, improving referral coordination, linking patients to transportation and financial support, integrating community navigation with oncology services, strengthening communication between healthcare facilities and communities, and reducing barriers to timely cancer treatment attendance across Nigeria.

Keywords: Community-based cancer navigation, cancer treatment attendance, patient navigation, cancer care, oncology services, treatment adherence, treatment interruption, cancer service utilization, community healthcare, Nigeria, public health.